The prevalence of pulmonary and extrapulmonary tuberculosis in forensic autopsies in a teaching hospital in South India.

Introduction: An autopsy is a valuable tool for finding the cause of death, exploring the clinical diagnosis, documenting unexpected findings, and resolving diagnostic questions. However, this may subject the forensic pathologist and other workers to a wide variety of blood-borne and aerosolized pathogens. Tuberculosis (TB) is the most common cause of illness and death, resulting in infection transmission in the autopsy room. Our objective in this study was to estimate the prevalence of pulmonary and extrapulmonary tuberculosis among forensic autopsies in a tertiary care hospital in South India. Material and Methods: We identified positive TB cases from acid-fast bacteria staining and culture (Mycobacterium Growth Indicator Tube and Lowenstein-Jensen medium) out of 380 autopsy cases. Results: The prevalence of tuberculosis was 2.4% (n = 9), among which 2.1% of cases were positive for only pulmonary tuberculosis (n = 8), and 0.3% of cases had both pulmonary and extrapulmonary involvement (n = 1). In the bivariate analysis of TB cases, sex, occupation, family history of TB, habit of smoking, BCG vaccine scar, period of hospital stay, and cause of death were potentially significant. Conclusion: The prevalence of TB in forensic autopsy cases were similar to forensic autopsy-based studies, and it was less as compared to the prevalence of TB in the general population.

Fatal anabolic androgenic steroid overdose in an amateur bodybuilder: a clinical and autopsy report.

Stanozolol is a synthetic anabolic-androgenic steroid commonly used by bodybuilders to increase muscle mass. However, its use can lead to serious adverse effects on the liver, including cholestasis, hepatic necrosis, and even death. In this case report, we describe a fatal case of stanozolol overdose in an otherwise healthy 35-year-old amateur bodybuilder. The patient presented with general malaise, jaundice, and a history of hematemesis after taking stanozolol tablets orally for 3 months. Upon admission, his liver function tests were significantly abnormal, and he succumbed within 48 h despite symptomatic treatment. The autopsy revealed sub-massive hepatic necrosis, focal macro-vesicular steatosis, and a cholestatic pattern of acute liver injury, with the chemical examination confirming the presence of stanozolol in the blood, liver, and kidneys. The cause of death was determined to be hepatic necrosis as a complication of stanozolol overdose. The overuse of anabolic steroids like stanozolol can cause hepatotoxicity, resulting in reversible cholestatic hepatitis or, in rare cases, fatal liver injury. The mechanism of anabolic androgenic steroid (AAS) drug-induced liver injury is obscure, but proposed mechanisms include oxidative stress and cholestasis. In this case, the recent overuse of stanozolol, a 17 alpha-alkylated (oral) AAS led to sub-massive hepatic necrosis and subsequent liver failure, proving fatal. It is imperative that healthcare providers and the public are informed about the dangers of AAS use, especially since AAS usage has increased recently due to easy online access, to prevent potentially life-threatening consequences.

Nomogram based Postmortem-interval estimation compared with the Actual death-interval in Tropical environmental conditions.

BACKGROUND: Estimating an accurate postmortem interval (PMI) is essential for death investigators to confirm the offence timing and suspects' alibis. Compared to traditional methods, the Nomogram-based method is claimed to estimate nearly accurate PMI, but most of such studies are based on the Western population. Adequate data for bodies exposed to tropical climate of India and the Indian subcontinent are not available. AIM: To assess the accuracy and goodness-of-fit of Nomogram based PMI estimation in bodies exposed to Indian climatic conditions after death. MATERIAL AND METHODS: This is a 3-year-long study on 200 bodies with known death times. The exact PMI was recorded from direct sources: family members, police and hospital records. Before autopsy, the ambient temperature, body weight, length, and rectal temperature were measured, and the details of clothing, sex, and age, were used on a nomogram to calculate the PMI (tN). One-way ANOVA correlation and Mann-Whitney U test were used to compare the variables. Linear regression analysis was used to establish the relationship between the rectal temperature (Tr) and nomogram estimated PMI (tN) and the known PMI(t). The consistency and agreement between the tN and t were measured using Intra-class correlation coefficient (ICC). Bland-Altman (BA) plot was used to compare the level of agreement between direct(t) and nomograms method PMIs. RESULTS: Nomogram-based PMI estimation showed a statistically significant strong relationship with rectal temperature (R 0.77, R2 0.74, adjusted R2 0.76, t-stat 25.83 p < 0.000) and exhibited a relatively consistent agreement with the known death interval (ICC 0.935). Regressing the tN over t showed that the nomogram method can predict PMI with 95 % accuracy. The BA plot between Direct and Nomogram methods exhibited a consistent agreement in PMI estimation though the limits of agreement (LoA) were wide: range 39.09-121.18 min. CONCLUSION: The accuracy and reliability of the Nomogram method in PMI estimation is high and recommended for the South Indian population. However, the presence of systematic differences between tN and t can't be ruled out due to wider LoA in BA plot. Hence, these findings highlight the need for further investigation and potential refinement of the PMI estimation methods to enhance accuracy and reduce discrepancies.

Cholemic Nephrosis: An Autopsy Study of a Forgotten Entity.

OBJECTIVE: The aim of the study is to do a clinicopathologic study of post mortem kidney biopsies with significant deposition of bilirubin pigment within tubular epithelial cells and in the lumen of distal tubules as a bile cast. MATERIAL AND METHOD: All post mortem specimens with acute tubular necrosis, with the presence of bile casts in tubules or bile pigment deposition in the tubular epithelium during the period 2015-2018 were examined for gross and histopathology along with biochemical parameters and viral markers. RESULTS: Bile casts with sloughed renal tubular epithelial cells and occasional macrophages were present in the distal convoluted tubule in 78.6% of biopsies (11/14). The plugging of distal convoluted tubule with casts was similar to that seen in myeloma and myoglobin cast nephropathies. Bilirubin pigment deposition was present in 35.7% (5/14) of cases. The frequency of bile casts in each biopsy was variable and it did not have any association with serum bilirubin levels or etiology of liver dysfunction. A striking difference from earlier studies is the high number of toxin-induced liver damage including six cases of paraquat and 2 cases of yellow phosphorus poisoning. CONCLUSION: This study proves importance of the bile cast nephropathy as a reason for kidney injury, especially with varied hepatotoxic etiologies, especially paraquat and yellow phosphorus.

Fatality Due to Button Battery Lodgment in the Upper Digestive Tract of a Neonate: An Unusual Presentation.

Foreign body ingestion is not uncommonly seen in children, with most such ingestions occurring between 6 months to 3 years of age. Button battery ingestion constitutes approximately 2% of all ingested foreign bodies in children. Button batteries are disc-shaped power units used for various electronic appliance, gadgets, and toys and often contain various toxic chemical substances such as heavy metal salts and alkali. Button batteries may become lodged in the upper digestive tract, producing severe damage to the adjacent tissues by various mechanisms. A death of a neonate due to a button battery lodging in the upper digestive tract leading to tracheoesophageal fistula and esophageal perforation is presented. To the best of authors' knowledge, the present case is the youngest death reported due to button battery lodgment, and the challenges of investigation in such a case are discussed.

Atypical Exit Wound in High-Voltage Electrocution.

Electrocution fatality cases are difficult to investigate. High-voltage electrocution burns resemble burns caused by other sources, especially if the person survives for few days. In that case, circumstantial evidence if correlated with the autopsy findings helps in determining the cause and manner of death. In addition, the crime scene findings also help to explain the pattern of injuries observed at autopsy. A farmer came in contact with a high-voltage transmission wire and sustained superficial to deep burns over his body. A charred and deeply scorched area was seen over the face, which was suggestive of the electric entry wound. The exit wound was present over both feet and lower leg and was atypical in the form of a burnt area of peeled blistered skin, charring, and deep scorching. The injuries were correlated with crime scene findings, and the circumstances that lead to his electrocution are discussed here.

Fatal Folic Acid Toxicity in Humans.

Folic acid is B-9 vitamin. Folic acid is prescribed commonly for pregnant women to prevent neural tube defects in the fetus, patients under chemotherapy, pernicious anemia and to reduce the risk of stroke and cardiovascular disease. Acute or chronic ingestion of a large dose of folic acid generally manifests as neurological complications, which are reversible. In this present case, a 23-year-old pregnant woman committed suicide by consuming folic acid tablets and succumbed to death within 36 h. Postmortem toxicological analysis detected folic acid in viscera. Death following acute consumption of folic acid is rare and has been not reported in the literature, to the best of our knowledge.

Paraphenylenediamine Containing Hair Dye: An Emerging Household Poisoning.

Paraphenylenediamine poisoning is among one of the emerging causes of poisoning in Asian countries, because it is a constituent of hair dye formulations and is easily available in market at low cost. Hair dyes are rampantly used in Asian households compared with the western world. Locally, hair dye constituents may have allergic adverse effects, and acute systemic poisoning presents with characteristic angioedema, upper airway obstruction, rhabdomyolysis, methemoglobinemia, myoglobinuria, and acute renal failure. This study reports about the death of a 24-year-old Indian housewife who committed suicide by taking hair dye emulsion. She had an argument with her husband, and because of fit of rage, took a bowlful (80 mL) of hair dye emulsion kept prepared for the use by husband. She developed angioedema, cervical swelling, and rhabdomyolysis and died of acute renal failure within 24 hours. Toxicological analysis of viscera and blood revealed varying levels of paraphenylenediamine. Histopathological samples of kidney showed features of acute tubular necrosis and myoglobin casts in renal tubules. The aim of the study is to create awareness about the adverse effects of the hair dye, its poisoning outcome, and possible preventive measures.

Occupational death due to bilateral carotid artery occlusion - a medico-legal case report.

Occupational deaths are work-related deaths and usually occur in the work place of an individual. A case of occupational death in a female factory worker has been described, where the saree she was wearing accidentally got entangled in the moving belt and caused ligature strangulation. She was unconscious throughout indicating bilateral occlusion of the carotids and died a day after the incident. The authors have described the correlation between the distribution of the injuries on the body and the manner a saree is worn. Investigation of the workplace revealed that the place where she was standing was located between two machines, and the space was inadequate for normal movement. Some suggestions have been offered which may decrease the incidences of occupational ligature strangulation due to entanglement of dress materials in the moving machineries.

Impulsive frotteurism: a case report.

Frotteurism is a perverted sexual behaviour wherein the person tends to rub or bring about physical contact between his genitals and an unrelated female or male to derive sexual pleasure. Moreover, frotteurism is a common phenomenon among the general population which usually goes unnoticed or overlooked. Nevertheless, public frottage has legal implications in almost all countries over the world. But, when frotteurism manifests on the backdrop of psychiatric illness or as a developmental abnormality then it is worth discussing what the legal liability would be. The present case report is based on hypersexual frotteuristic behaviour manifested on the background of a concealed psychiatric illness, featuring depression and obsessive compulsive disease. The hypersexual behaviour manifested in the form of masturbation with features of frotteurism and subsequent development of depression. Nevertheless, compulsive manifestation of frotteuristic behaviour and subsequent development of morbid depression is rare. This paper describes a 12-year-old boy having unrestrained impulsive frotteurism with his peers, school mates and with his younger brother. He was conscious of the fact and feeling guilty of what he was doing but unable to restrain himself. It was followed by the development of symptoms of depression which was treated with Sertraline. Concurrent psychiatric counseling and rehabilitation measures were taken too. There was complete remission of the symptoms 6 months after the onset of treatment and without relapse thereafter. The paper discusses the differential diagnosis and management of hypersexual behaviour.

High-voltage suicidal electrocution with multiple exit wounds.

Poisoning, hanging, and burning are the usual methods adopted by people to commit suicide. Suicide by electrocution and that too high voltage is one of the rarest methods adopted for the purpose. We report the case of a young man who committed suicide by climbing up a 25-ft-high electric pole. The deceased was a regular alcoholic and was under severe depression for a long time because of his personal problems. He survived for more than 2 days after the incident. His serum urea and creatinine levels were elevated, so were the creatine kinase total and creatine kinase-MB level. The method adopted and the findings make this case a rare scientific report. Moreover, to the best of our knowledge, this is the first reported case in an English scientific literature of a high-voltage suicidal electrocution with multiple exit wounds. The circumstances surrounding the manner of electrocution and the features of electric injuries are presented and discussed.

Electrocution-related mortality: a retrospective review of 118 deaths in Coimbatore, India, between January 2002 and December 2006.

Electrical injuries currently remain a worldwide problem. These injuries are responsible for considerable morbidity and mortality, but are usually preventable with simple safety measures. A retrospective study was undertaken of deaths due to electrocution that occurred over a five-year period from January 2002 to December 2006. The bodies were autopsied at the Department of Forensic Medicine, Coimbatore Medical College and Hospital, Coimbatore, Tamil Nadu, India. A total of 118 cases were identified and all were accidental: 107 males (91%) and 11 females (9%) (male:female ratio = 9.72). The majority of deaths occurred in the 21-30 year age group (n = 57, 48%). Most deaths (n = 98; 83%) were due to low-voltage circuits (< 1000 V); a minority were due to high voltages (n = 20, 17%). Domestic accidents were responsible in 73 cases (61.86%). Deaths were caused most frequently by touching an electric wire (n = 62; 52.54%). Most deaths occurred in the summer (n = 50; 42%) with the lowest number of deaths occurring in winter. There was no electrical contact mark present in eight cases (6.7%). One hundred and four cases (88%) were dead on arrival at hospital. The most common cause of death was cardiac arrest, followed by septicaemia and renal failure. Congestion of the brain and oedematous lungs were frequent non-specific postmortem findings.

Alleged dowry death: a study of homicidal burns.

Homicidal burning of married women in India is a major concern for the Government, law-enforcing authorities, the judiciary, the police and medico-legal experts all over the country who are associated with dowry disputes. Dowry death, a heinous crime, is gradually engulfing and polluting the entire society. Sections 304(B) and 498(A) of the Indian Penal Code (IPC) have been introduced and Sections 174 Criminal Procedure Code (Cr PC) and 176 Cr PC have been modified but, instead of deterring dowry deaths, the occurrences are increasing day by day and the number of cases coming for post-mortem examination is rising. Both parties, that is, the parents and in-laws of the deceased, are becoming adept at manufacturing circumstantial evidence to serve their own interests. Therefore, to establish the truth and for the smooth administration of justice, reliable unbiased medical evidence has to be corroborated. This study presents retrospective research carried out in the tertiary care teaching hospital of MKCG Medical College, Berhampur, Eastern India, for a five-year period between January 1998 to December 2002. From a total of 58 burned wives, 32 (55.1%) were homicidal burns. These cases were analyzed in view of epidemiological and medico-legal aspects. The majority of the affected women (90.63%) were in the 18 to 26 years of age group. Death occurred within the first few years of marriage and most of them had no children. All the victims belonged to the Hindu religion and 62.5% of incidents occurred during the daytime. In 71.87% cases the incident occurred in rural areas. Eighty-three per cent of cases occurred in a joint family within the house. In most cases, kerosene was the accelerant and flame was the causative agent. In more than 68.75% of cases the total body surface area involved was more than 80%. Most victims died at the time of the incident, or within the subsequent 24 hours, due to hypovolumeic shock. The education status in 70.21% cases was either illiterate or under matriculation. More stringent laws and female independence both mentally and economically will reduce the homicidal burns in young brides.